Provider Demographics
NPI:1528008448
Name:VASHISHTA, NISHA (MD)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:VASHISHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4639 E PICKARD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2077
Mailing Address - Country:US
Mailing Address - Phone:989-817-4300
Mailing Address - Fax:989-817-4301
Practice Address - Street 1:4639 E PICKARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2077
Practice Address - Country:US
Practice Address - Phone:989-817-4300
Practice Address - Fax:989-817-4301
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4426947Medicaid
MI4426947Medicaid
0N52880008Medicare ID - Type Unspecified